Provider Demographics
NPI:1083643852
Name:AMARILLO COLONOSCOPY CENTER LP
Entity Type:Organization
Organization Name:AMARILLO COLONOSCOPY CENTER LP
Other - Org Name:PANHANDLE ENDOSCOPY CENTER LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMBASIVA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:MARUPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-367-8537
Mailing Address - Street 1:800 QUAIL CREEK DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1634
Mailing Address - Country:US
Mailing Address - Phone:806-367-8537
Mailing Address - Fax:806-367-8538
Practice Address - Street 1:800 QUAIL CREEK DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1634
Practice Address - Country:US
Practice Address - Phone:806-367-8537
Practice Address - Fax:806-367-8538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008144261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00300440OtherRAILROAD MEDICARE
TXHH039AOtherBLUE CROSS BLUE SHIELD
07690690OtherAETBA INS CO
P00300440OtherRAILROAD MEDICARE